Evaluation of Washington, Dc's NOVEL Chlamydia/Gonorrhea Reactor GRID

Background: Due to dwindling resources, the District’s STD Control Program couldn’t continue to investigate all chlamydia/gonorrhea cases and therefore implemented a Reactor Grid to prioritize field follow-up of treatment based on the sex, age, HIV status, and provider of persons with positive tests for chlamydia or gonorrhea. 

Objectives: To evaluate the effectiveness of this tool in prioritizing field investigations of persons testing positive for chlamydia or gonorrhea.

Methods: We analyzed the demographics and dispositions of reported chlamydia and gonorrhea cases 9 months prior to (January 1, 2010 – September 30, 2010) and 9 months following (October 1, 2010 – June 20, 2011) the institution of this tool (October 1, 2010).

Results: Demographics of all reported cases were similar.  The number of cases that had a field record initiated decreased from 2,380 (41.4%) of 5,753 cases to 1,277 (22.1%) of 5,783 cases.  During this time we saw an increase in the percentage of cases < 26 years of age (from 79.5% to 94.4%), an increase in persons brought to treatment (from 41.6% to 52.5%), and a decrease in those who were already treated (from 58.2% to 47.3%). 

Conclusions: This tool enabled field Disease Intervention Specialists to focus on our priority population (persons < 26 years of age) and disease interruption activities (such as ensuring provision of appropriate treatment) rather than merely confirming treatment.  Further evaluation is warranted to ensure that the 4,506 cases that weren’t initiated after implementation are low-priority and to investigate why 604 cases that were previously treated were initiated to the field.

Implications for Programs, Policy, and Research: Field staff resources should be targeted to priority populations and activities that contribute to true disease intervention.